间接测热法在特重度烧伤救治中的应用价值

Explore the application of indirect calorimetry in the treatment of severe burn

目的研究间接测热法指导特重度烧伤患者营养治疗,探讨该方法对患者营养指标及预后的影响。方法采用回顾性分析匹配对照的研究方法。纳入2020年6月13日至7月31日本院重症医学科收治的6-13温岭槽罐车爆炸事故中受伤的15例特重度烧伤患者为测定组,该组患者均应用代谢车间接测热法(indirect calorimetry,IC)每周1次测定能量需求,据此指导营养干预。同时纳入本院2018年6月至2019年6月收治的18例特重度烧伤患者为公式组,该组患者均使用第三军医大烧伤营养公式(KJ/d=4104x体表面积M2+105x烧伤面积%)估算能量需求。统计比较两组患者入院时及入院后第1-6周白蛋白、视黄醇结合蛋白、血红蛋白和淋巴细胞绝对值等营养相关指标。以死亡为终点事件,使用Kaplan-Meier曲线进行生存分析。结果测定组和公式组入院时各营养指标差异无统计学意义。测定组入院后第1、2、3周白蛋白[(32.79±3.88)、(33.71±5.42)、(35.56±10.09)]g/L均高于公式组[(25.69±5.76)、(25.70±5.29),(29.26±5.40)]g/L。具差异有统计学意义(P<0.05)。测定组入院后第1、2、4、5、6周视黄醇结合蛋白[(28.71±12.24)、(27.71±13.02)、(34.6±11.24),(45.09±15.90)、(46.11±10.82)]mg/L,均高于公式组[(11.06±10.99)、(17.08±12.06)、(17.73±14.11)、(21.56±13.26)、(21.60±13.43)]mg/L,差异有统计学意义(P<0.05)。两组间各周血红蛋白和淋巴细胞绝对值差异无统计学意义。测定组生存率为80.0%(12/15),公式组为55.6%(10/18)。使用Breslow检验,两组生存曲线差异有统计学意义(/>=0.033)。结论使用IC法测定能量需求指导特重度烧伤患者的营养支持治疗,可以早期改善患者的营养状况,利于提高早期生存率。

Objective To investigate the effect of indirect calorimetry on nutritional treatment of patients with severe bums,and to explore the influence of this method on nutritional indicators and prognosis of patients.Methods The research method of retrospective analysis matching control was adopted.Fifteen patients with severe bums who were injured in the explosion of the 6.13 Wenling Tank Truck in the Department of Intensive Medicine of our hospital from June 13 to July 31,2020 were served as a measured group,and all of the patients in this group used the indirect heat measurement method of Indirect Calorimetry,IC once a week to determine energy demand and guide nutritional intervention.At the same time,18 patients with severe bums treated by our hospital from June 2018 to June 2019 were included in the formula group,which were treated with the third military medical university bum nutrition formula(KJ/d-4104 x body surface area M2 x 105 x bum area)to estimate energy demand.Nutritionrelated indicators such as albumin,retinol binding protein,hemoglobin and absolute value of lymphocytes at the time of hospitalization and weeks 1-6 after hospitalization were compared.Death-ending events were analyzed using the Kaplan-Meier curve.Results There was no significant difference in nutritional index between the measured group and the formula group when they were admitted to the hospital.Albumins 32.79±3.8&33.71±5.42,35.56±10.09 g/L of the measured group were significantly higher than those of the formula group 25.69±5.76,25.70±5.29,29.26±5.40 g/L at week 1,2 and 3 after admission(all P<0.05).Retinol binding proteins 28.71±12.24,27.71±13.02,34.6±11.24,45.09±15.90,46.11±10.82 mg/L in the measured group were significantly higher than those in the formula group 11.06±10.99,17.08±12.06,17.73±14.11,21.56±13.26,21.60±13.43 mg/L at week 1,2,4,5 and 6 after admission(all P<0.05).There were no significant differences in absolute values of hemoglobin and lymphocytes between the two groups.The survival rate of the measured group was 80.0%(12/15)and that of the formula group was 55.6%(10/18).Using Breslow test,there was a significant difference between the two sets of survival curves(P=0.033).Conclusion Using the IC method to determine energy demand to guide the nutritional support treatment of patients with severe bums can improve the nutritional status of patients at an early stage and improve the early survival rate.